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D CORE LABORATOR , INC. No. 1'd 7 C. O U <br /> CHAIN OF CUSTODY RE&D <br /> CUSTOMER INFORMATION PROJECT INFORMATION OO <br /> COMPANY �" � � PROJECT UMBE �'-7 .Z` <br /> ` ; I 3 (n AZ <br /> SEND REPORT TO y Llkq) `R11 I.1 G INFORMATION y -Y4/co , <br /> ADDRES yS BILL TO l < <br /> L { a./L� z <br /> ADDRESS Vcciv Q� <br /> - �`� d LL �_� r LAB JOB NO. <br /> LU <br /> PH /��,'] ^C C7 PHONE ca � <br /> FAX ZS -c/ FAX PO NO <br /> SAMPLE NO 1�SAMPLE []ESCRIPTIC4! OAATTEE SAMPLE <br /> SANPLE <br /> MATRIX WNTAINER PRESERV REMARKS / PRECAUTIONS <br /> Y Y r rr - i <br /> vv <br /> ki 3 X'k w ws - <br /> w- i-1`�1 Cavi L K X <br /> 1 <br /> s <br /> w <br /> c� 1 <br /> ¢ <br /> a <br /> 0 <br /> SAMPLER SHIPMENT METHOD AIRBILL NO <br /> in I <br /> cc REOUIRED TUR ROUND* ❑ SAME DAY ❑ 24 HOURS C 46 HOURS ❑72 HOURS ❑5 DAYS [_ 10 DAYS ❑ ROUTINE OTHER <br /> a <br /> a 1 RELINOUIS ED Y DATE 2 RELINQUISHED BY DATE 3 RELINQUISHED BY DATE <br /> c SIGNATUR SIGNATURE SIGNATURE <br /> 0 <br /> PRINTED NAME/COMPANY TIME PRINTED NAM OMPANY TIME PRINTED NAMEICOMPANY TIME <br /> 0 <br /> a 1 RECEIVED BY DATE 2 RECEIVE Y OAT 3 RECEIVED BY <br /> Z DATE <br /> SIGNATURE J _ SIGNAT 0/czi SIGNATURE <br /> c=n <br /> Q PRINTED NAMEICO oL �� T � PRINTED E ANY TI1� PRINTED NAMElCOMPANY TIME <br /> i • t <br /> ❑ Anaheim CA ❑ Aurora CO ❑ Cooper WY 13 Corpus Chrfstl TX <br /> 1250 E Gene Autry Way 10703 E Bethany Onve 420 W Frsl Street 1733 N Padre Island Dave <br /> Anaheim CA 92805 Aurora CO 60014 Casper WY 82601 Carpus Christi TX 78408 <br /> (714)937 1094 Fax(714)937 1170 (303)751 1780 Fax(303)751 1784 <br /> (307)235 5741 Fax(307)266 1676 (367)269 2673 Fax(361)269 2471 <br /> ❑ Houston TX(Env) Q Houston Tx(Pet) Q Lake Charles LA ❑ Valparaiso IN <br /> 6310"way DrWe 8210 Mosley Road 3645 Beghs Parkway 2400 Cnmherland Drve <br /> 1louslon TX 77040 Houston TX 77075 Sulphur LA 70663 Valparaiso IN 46383 I <br /> (713)690-4444 Fax(713)6903646 (713)943 9776 Fax{7131943 3846 (318)583 4928 Fax(318)5833928 <br /> (219)464 2399 Fax(219)462 2953 <br />